While many viruses can cause cough and trouble breathing, Respiratory Syncytial Virus (RSV) is well known for causing bronchiolitis, a lower airway tract infection in children. Bronchiolitis is when the small airways in the lungs, or the bronchioles, become inflamed with secretions. This can cause respiratory distress in children, particularly babies.
It often also leads to dehydration, as babies must breathe through their noses while eating and cannot feed well with severe congestion. In addition, RSV can cause nausea in some children, with the child refusing to eat. RSV often worsens for a few days before it starts to get better. If you have concerns about your child’s breathing or feeding that are not adequately addressed by the suggestions above, please seek medical attention.
Many children with viral respiratory infections are managed as outpatients. If your child does not require hospitalization, then I counsel families to monitor closely for reasons to return to medical care. Most children with viral respiratory illness recover without difficulty; however, reasons to return include becoming dehydrated, having persistent fever, or developing lethargy.
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Look for signs of dehydration. If your baby is not making tears or only has 2-3 wet diapers in 24 hours, that is concerning for dehydration. I also discuss with families to look for signs of secondary bacterial infection. Viral infections in children can cause inflammation and fluid in the lung airways and in the middle ears. Typically, this resolves after your child’s immune system fights off the virus. However, if your child has had mild symptoms for several days, then suddenly worsens, or has a new fever, they should be evaluated to determine the cause, as it could be a bacterial infection occurring on the tails of the viral infection.
These are the other symptoms I tell parents to watch for: true lethargy (not just decreased energy that resolves with Ibuprofen/Tylenol), altered mental status, fevers greater than five days, difficulty breathing, difficulty feeding, severe headaches, severe abdominal pain, signs of dehydration, or any other concerns.
If your child’s symptoms do not improve with treatment at home, all caregivers should know your preference for which hospital a child should be taken to in case of an emergency. Our Washington University Children’s After Hours locations provide convenient medical care for your child’s illnesses and injuries as a faster alternative to ERs when your pediatrician’s office is closed.
In case of a medical emergency with a child, determine where the nearest accredited, Level I pediatric trauma center is located. St. Louis Children’s Hospital has six pediatric ER locations across the St. Louis and southern Illinois region including St. Louis Children’s Hospital, Children’s Hospital at Memorial Hospital Belleville, Children’s Hospital at Memorial Hospital Shiloh, Children’s Hospital at Missouri Baptist Medical Center, Children’s Hospital at Northwest HealthCare and Children’s Hospital at Progress West Hospital.